Nasal Intermittent Positive Pressure Ventilation Group Research Articles

The Outcomes of Preterm Infants with Neonatal Respiratory Distress Syndrome Treated by Minimally Invasive Surfactant Therapy and Non-Invasive Ventilation.

In recent years, the utilization of minimally invasive surfactant therapy (MIST) and Non-invasive ventilation (NIV) as the primary respiratory assistance has become increasingly prevalent among preterm infants with neonatal respiratory distress syndrome (RDS). This study aims to compare the outcomes between MIST administered with nasal continuous positive airway pressure (NCPAP) versus nasal intermittent positive pressure ventilation (NIPPV), with the objective of exploring the respiratory therapeutic benefits of these two approaches. This retrospective study collected data from the neonatal intensive care unit of Kaohsiung Medical University Hospital spanning from January 2016 to June 2021. Infants were divided into two groups based on the type of NIV utilized. The NCPAP group comprised 32 infants, while the NIPPV group comprised 22 infants. Statistical analysis revealed significant differences: the NIPPV group had a smaller gestational age, lower birth weight, higher proportion of female infants, and earlier initiation of MIST. Additionally, the NIPPV group exhibited higher incidence rates of retinopathy of prematurity, longer respiratory support duration, prolonged hospitalization, and mortality. However, upon adjustment, these differences were not statistically significant. Analysis of venous blood gas and respiratory parameter changes indicated that both the NCPAP and NIPPV groups experienced improvements in oxygenation and ventilation following MIST.

Comparative Effect of High-Frequency Nasal Cannula and Noninvasive Ventilation on the Work of Breathing and Postoperative Pulmonary Complication after Pediatric Congenital Cardiac Surgery: A Prospective Randomized Controlled Trial.

Various forms of commonly used noninvasive respiratory support strategies have considerable effect on diaphragmatic contractile function which can be evaluated using sonographic diaphragm activity parameters. To compare the magnitude of respiratory workload decreased as assessed by thickening fraction of the diaphragm and longitudinal diaphragmatic strain while using high-flow nasal cannula (HFNC) and noninvasive ventilation (NIV) modes [nasal intermittent positive pressure ventilation (NIPPV) and bilevel positive airway pressure (BiPAP)] in pediatric patients after cardiothoracic surgery. This prospective randomized controlled trial was performed at a tertiary care surgical intensive care unit in postcardiac surgery patients aged between 1 and 48 months, who were randomly allocated into three groups: 1) HFNC (with flows at 2 L/kg/min), 2) NIPPV via RAMS cannula in PSV mode (pressure support 8 cmH2O, PEEP 5 cmH2O), and 3) BiPAP in nCPAP mode (CPAP of 5 cmH2O). Measurements were recorded at baseline after extubation (R0) and subsequently every 12 hourly (R1, R2, R3, R4, R5) at 12, 24, 36, 48, and 60 hours respectively until therapy was discontinued. Sixty patients were included, with 20 patients each in the NIPPV group, HFNC group, and BiPAP group. Longitudinal strain at crura of diaphragm was lower in the BiPAP group as compared to HFNC group at R2-R4 [R2 (-4.27± -2.73 vs - 8.40± -6.40, P = 0.031), R3 (-5.32± -2.28 vs -8.44± -5.6, P = 0.015), and R4 (-3.8± -3.42 vs -12.4± -7.12, P = 0.040)]. PFR was higher in HFNC than NIPPV group at baseline and R1-R3[R0 (323 ± 114 vs 264 ± 80, P = 0.008), R1 (311 ± 114 vs 233 ± 66, P = 0.022), R2 (328 ± 116 vs 237 ± 4, P = 0.002), R3 (346 ± 112 vs 238 ± 54, P = 0.001)]. DTF and clinical parameters of increased work of breathing remain comparable between three groups. The rate of reintubation (within 48 hours of extubation or at ICU discharge) was 0.06% (1 in NIPPV, 1 in BiPAP, 2 in HFNC) and remain comparable between groups (P = 1.0). BiPAP may provide better decrease in work of breathing compared to HFNC as reflected by lower crural diaphragmatic strain pattern. HFNC may provide better oxygenation compared to NIPPV group, as reflected by higher PFR ratio. Failure rate and safety profile are similar among different methods used.

Efficacy of noninvasive high-frequency oscillatory ventilation versus nasal intermittent positive pressure ventilation as post-extubation respiratory support in preterm infants: a Meta analysis

To systematically evaluate the efficacy and safety of noninvasive high-frequency oscillatory ventilation (NHFOV) versus nasal intermittent positive pressure ventilation (NIPPV) as post-extubation respiratory support in preterm infants. China National Knowledge Infrastructure, Wanfang Data, Chinese Journal Full-text Database, China Biology Medicine disc, PubMed, Web of Science, and the Cochrane Library were searched for articles on NHFOV and NIPPV as post-extubation respiratory support in preterm infants published up to August 31, 2022. RevMan 5.4 software and Stata 17.0 software were used for a Meta analysis to compare related indices between the NHFOV and NIPPV groups, including reintubation rate within 72 hours after extubation, partial pressure of carbon dioxide (PCO2) at 6-24 hours after switch to noninvasive assisted ventilation, and the incidence rates of bronchopulmonary dysplasia (BPD), air leak, nasal damage, periventricular leukomalacia (PVL), intraventricular hemorrhage (IVH), and retinopathy of prematurity (ROP). A total of 9 randomized controlled trials were included. The Meta analysis showed that compared with the NIPPV group, the NHFOV group had significantly lower reintubation rate within 72 hours after extubation (RR=0.67, 95%CI: 0.52-0.88, P=0.003) and PCO2 at 6-24 hours after switch to noninvasive assisted ventilation (MD=-4.12, 95%CI: -6.12 to -2.13, P<0.001). There was no significant difference between the two groups in the incidence rates of complications such as BPD, air leak, nasal damage, PVL, IVH, and ROP (P>0.05). Compared with NIPPV, NHFOV can effectively remove CO2 and reduce the risk of reintubation, without increasing the incidence of complications such as BPD, air leak, nasal damage, PVL, and IVH, and therefore, it can be used as a sequential respiratory support mode for preterm infants after extubation.

Efficacy and safety of nasal intermittent positive pressure ventilation and nasal continuous positive airway pressure ventilation in neonatal respiratory distress syndrome: a systematic review and meta-analysis.

BackgroundThe efficacies of nasal continuous positive airway pressure (NCPAP) and nasal intermittent positive pressure ventilation (NIPPV) in neonatal respiratory distress syndrome (RDS) are controversial. The reasons for controversy may be the selection bias of research objects and the small sample size.MethodsLiterature retrieval was performed in PubMed, EMBASE, Medline, Central, China National Knowledge Infrastructure (CNKI), Wanfang and China Science Digital Library (CSDL) databases. Inclusion criteria: (I) literatures involving subjects who were newborns with RDS; (II) studies that had established both experimental and control groups; (III) the intervention measures of the experimental and control groups were NIPPV and NCPAP, respectively; (IV) the results included the incidence of intubation, bronchopulmonary dysplasia (BPD), or mortality; and (V) randomized controlled trials (RCTs). The chi-square test was applied for heterogeneity test. Publication bias assessment was conducted by funnel plot and Egger’s test. The revised Cochrane risk of bias tool for individually randomized, parallel group trials (RoB2.0) was used to evaluate the risk of bias of the included RCT research.ResultsA total of 10 literatures were included for analysis, including 1,104 patients, 557 in the NIPPV group and 547 in the NCPAP group. Among the literatures, 2 literatures had low risk of bias, 2 literatures had high risk of bias, and the rest had uncertain risk of bias. Compared to NCPAP, NIPPV reduced the incidence of neonatal intubation in RDS [risk ratio (RR) =0.57, 95% confidence interval (CI): 0.46–0.71, Z=5.11, P<0.00001]. There was no statistically significant heterogeneity (P=0.13, I2=36%) or publication bias (P<0.05) among the studies. Compared with NCPAP, NIPPV reduced the incidence of BPD in RDS (RR =0.72, 95% CI: 0.57–0.91, Z=2.70, P=0.007). There was no statistically significant heterogeneity (P=0.10, I2=41%) or publication bias (P>0.05) among the studies. NIPPV reduced the neonatal mortality rate of RDS (RR =0.55, 95% CI: 0.31–0.97, Z=2.08, P=0.04). There was no statistically significant heterogeneity (P=0.20, I2=38%) or publication bias (P>0.05) among the studies.DiscussionCompared with NCPAP, NIPPV can reduce the incidence of intubation, BPD, and mortality. The conclusions need to be confirmed via high-quality RCTs.

Use of Non-Invasive Ventilation in Reducing Partial Pressure of Carbon Dioxide Level (PaCO2) in Neonates with Respiratory Distress Syndrome

Objective: It has been observed that non-invasive ventilation used in premature with Respiratory distress syndrome and notably decrease level of partial pressure of carbon-dioxide (PaCO2) level in blood. The primary goal of this study was to assess the effect of non-invasive ventilation in decreasing the level of partial pressure of carbon dioxide (PaCO2) level and supplementary oxygen need in premature neonates with RDS. Study Design and Settings: This randomized controlled trial was done in Jan 2021 till August 2021 at PNS SHIFA Karachi. Methodology: Neonates with gestational age (GA &lt;34 wk) with RDS at birth were randomly assigned to nasal intermittent positive pressure ventilation (NIPPV) and nasal high frequency oscillatory ventilation (NHFOV) for respiratory support after giving surfactant .Twenty three preterm babies were included in each group .Level of partial pressure of carbon dioxide at 2hrs and 24hrs of non-invasive ventilation and supplementary oxygen need was evaluated. Results: Non-invasive ventilation was found to reduce the PaCO2 level (p= .01), NIPPV (43.06±13.74) vs. (33.63±19.99) in NHFOV at 2hrs and 24hrs NIPPV (19.89±7.18) vs. NHFOV (14.04±8.39).Value of pH was also significant in two groups with optimal mean airway pressure. Supplementary oxygen period were also reduced in NHFOV than NIPPV group (35.7% vs. 64.3%). Conclusion: NHFOV was a beneficial mode in maintaining level of pH, PaCO2 level and reducing need of supplementary oxygen in preterm babies with RDS

Nasal Continuous Positive Airway Pressure vs. Nasal Intermittent Positive Pressure Ventilation as Initial Treatment After Birth in Extremely Preterm Infants.

ObjectiveNon-invasive respiratory support strategies are known to reduce the complications of invasive mechanical ventilation in preterm infants. Nasal continuous positive airway pressure (NCPAP) and nasal intermittent positive pressure ventilation (NIPPV) are commonly used ones. The recent meta-analyses indicated that early NIPPV did appear to be superior to NCPAP for decreasing respiratory failure and the need for intubation among preterm infants with respiratory distress syndrome (RDS). The aim of the study was to compare the short-term outcomes of extremely preterm infants who received NCPAP or NIPPV as an initial treatment of RDS.MethodsThis retrospective study included infants born before 29 weeks' gestation between 1 January 2018 and 31 December 2021 who received non-invasive respiratory support with NCPAP or NIPPV. For every infant included in the cohort, only the first episode of NCPAP or NIPPV as initial treatment was evaluated. The primary outcome was the need for intubation within 72 h, and the secondary outcomes were the need for intubation within 7 days, administration of surfactant, prematurity-related morbidities, mortality, and death or bronchopulmonary dysplasia (BPD).ResultsDuring the study period, there were 116 inborn admissions of preterm infants born <29 weeks' gestation and 60 of them met the inclusion criteria. Of these, 31 (52%) infants received NCPAP while 29 (48%) infants received NIPPV at the first hours after birth. There were no differences in the baseline demographics between the groups (p > 0.05). Blood gas parameters (pH, pCO2, HCO3, and lactate) at admission were not different. The need for intubation within 72 h as the primary outcome was similar between NCPAP and NIPPV groups (35.5 vs. 34.5%, p = 0.935). The rates of surfactant requirement, need for intubation within 7 days, prematurity-related morbidities, mortality, and death/BPD were similar among the groups (p > 0.05).ConclusionNasal intermittent positive pressure ventilation is non-inferior to NCPAP as an initial treatment in extremely preterm infants with RDS. Although the rate of intubation in the first week, mortality, and BPD did not differ between groups, additional studies are needed and the synchronization of NIPPV should be evaluated.

Noninvasive High-Frequency Oscillatory Ventilation vs Nasal Continuous Positive Airway Pressure vs Nasal Intermittent Positive Pressure Ventilation as Postextubation Support for Preterm Neonates in China

Several respiratory support techniques are available to minimize the use of invasive mechanical ventilation (IMV) in preterm neonates. It is unknown whether noninvasive high-frequency oscillatory ventilation (NHFOV) is more efficacious than nasal continuous positive airway pressure (NCPAP) or nasal intermittent positive pressure ventilation (NIPPV) in preterm neonates after their first extubation. To test the hypothesis that NHFOV is more efficacious than NCPAP or NIPPV in reducing IMV after extubation and until neonatal intensive care unit discharge among preterm neonates. This multicenter, pathophysiology-based, assessor-blinded, 3-group, randomized clinical trial was conducted in 69 tertiary referral neonatal intensive care units in China, recruiting participants from December 1, 2017, to May 31, 2021. Preterm neonates who were between the gestational age of 25 weeks plus 0 days and 32 weeks plus 6 days and were ready to be extubated were randomized to receive NCPAP, NIPPV or NHFOV. Data were analyzed on an intention-to-treat basis. The NCPAP, NIPPV, or NHFOV treatment was initiated after the first extubation and lasted until discharge. Primary outcomes were total duration of IMV, need for reintubation, and ventilator-free days. These outcomes were chosen to describe the effect of noninvasive ventilation strategy on the general need for IMV. A total of 1440 neonates (mean [SD] age at birth, 29.4 [1.8] weeks; 860 boys [59.7%]) were included in the trial. Duration of IMV was longer in NIPPV (mean difference, 1.2; 95% CI, 0.01-2.3 days; P = .04) and NCPAP (mean difference, 1.5 days; 95% CI, 0.3-2.7 days; P = .01) compared with NHFOV. Neonates who were treated with NCPAP needed reintubations more often than those who were treated with NIPPV (risk difference: 8.1%; 95% CI, 2.9%-13.3%; P = .003) and NHFOV (risk difference, 12.5%; 95% CI, 7.5%-17.4%; P < .001). There were fewer ventilator-free days in neonates treated with NCPAP than in those treated with NIPPV (median [25th-75th percentile] difference, -3 [-6 to -1] days; P = .01). There were no differences between secondary efficacy or safety outcomes, except for the use of postnatal corticosteroids (lower in NHFOV than in NCPAP group; risk difference, 7.3%; 95% CI, 2.6%-12%; P = .002), weekly weight gain (higher in NHFOV than in NCPAP group; mean difference, -0.9 g/d; 95% CI, -1.8 to 0 g/d; P = .04), and duration of study intervention (shorter in NHFOV than in NIPPV group; median [25th-75th percentile] difference, -1 [-3 to 0] days; P = .01). Results of this trial indicated that NHFOV, if used after extubation and until discharge, slightly reduced the duration of IMV in preterm neonates, and both NHFOV and NIPPV resulted in a lower risk of reintubation than NCPAP. All 3 respiratory support techniques were equally safe for this patient population. ClinicalTrials.gov Identifier: NCT03181958.

Non-invasive high-frequency oscillatory ventilation in preterm infants after extubation: a randomized, controlled trial.

ObjectiveTo investigate the effectiveness and safety of non-invasive high-frequency oscillatory ventilation (NHFOV) in post-extubation preterm infants.MethodsThis was a randomized, controlled trial. A total of 149 preterm infants aged between 25 to 34 weeks’ gestational age with a birth weight of <1500 g who required invasive mechanical ventilation on admission were included. After extubation, they were randomized to the NHFOV group (n = 47), nasal intermittent positive pressure ventilation (NIPPV) group (n = 51), or nasal continuous positive airway pressure (NCPAP) group (n = 51). We compared the effectiveness and safety among these three groups.ResultsA total of 139 preterm infants finally completed the study. The reintubation rate was significantly lower in the NHFOV group than in the other groups. The duration of non-invasive ventilation and the length of hospital stay in the NHFOV and NIPPV groups were significantly shorter than those in the NCPAP group. The incidence of bronchopulmonary dysplasia in the NHFOV and NIPPV groups was significantly lower than that in the NCPAP group. The NHFOV group had significantly less nasal injury than the NCPAP group.ConclusionAs post-extubation respiratory support in preterm infants, NHFOV has a lower reintubation rate compared with NCPAP and NIPPV, without increasing the rate of complications.

Comparison of four different non-invasive respiratory support techniques as primary respiratory support in preterm infants.

The use of non-invasive ventilation methods in neonatal intensive care units has been increasing in recent years. Non-invasive ventilation techniques are lung preserving methods and they reduce the risk of volutrauma, barotrauma, and atelectotrauma. The effect of heated humidified high-flow nasal cannula (HHHFNC), continuous positive airway pressure (CPAP), nasal intermittent positive-pressure ventilation (NIPPV), and nasal high-frequency oscillation ventilation (NHFOV) were compared in preterm infants with respiratory distress. Between December 2015 and February 2017, a total of 76 preterm infants (gestational age < 32 weeks) with respiratory distress were enrolled in this study. Of the patients, 20 received HHHFNC, while 20 received nasal CPAP (NCPAP), 19 received NIPPV, and 17 received NHFOV for respiratory support. The primary outcome was intubation requirement during non-invasive respiratory support. The secondary outcome included duration of non-invasive ventilation, air leak syndrome, abdominal distension, intraventricular hemorrhage, necrotizing enterocolitis (NEC), nasal injury, increased secretions, agitation, and mortality rate. The intubation ratio was higher in the NCPAP (40%) and NHFOV (29.4%) groups when compared with the NIPPV (10.5%) and HHHFNC (11.8%) groups. More nasal injury had developed in the NIPPV (78.9%) and NHFOV (82.4%) groups when compared with the NCPAP (40%) and HHHFNC (35%) groups. Moreover, the viscous secretion that blocked the cannulas was higher in NIPPV (78.9%) and NHFOV (76.5%) groups than NCPAP (25%) and HHHFNC (40%) groups. There were no significant differences in the duration of non-invasive ventilation methods, abdominal distension, NEC, air leak syndrome or mortality in the 4 groups. The NIPPV and HHHFNC methods can be useful as a primary mode of respiratory support for respiratory distress. However, doctors need to be careful with regard to the complications that may develop.

Non-invasive ventilation provides adequate gas exchange minimizing pulmonary and extrapulmonary complications

The objective : to evaluate the effectiveness of NIPPV (nasal intermittent positive pressure ventilation) and NHFOV (nasal hig h-f requency oscillatory ventilation) modes in newborns in the delivery room depending on the gestation period. Subjects and methods. A prospective randomized study included 88 premature newborns with the body mass of 1,405 (1,085–1,760) gr. and gestation period 31 (29–32) weeks. In children of the first group, the NIPPV mode was used, and in the second group – NHFOV . Children of each group were divided into subgroups: subgroup 1 consisted of newborns with a gestation period of 30–32 weeks, subgroup 2 – 26–29 weeks. Results. The need for the traditional ventilator was significantly greater in the group of NIPPV – 15 children, compared to the group of NHFOV – 2 children ( p = 0.001). In the same subgroup, statistically significant differences were found in the frequency of bronchopulmonary dysplasia ( BPD ) and intraventricular hemorrhage ( IVH ) ( p &lt; 0.05). In particular, in the NIPPV group, BPD was registered in 33.3% of cases, while in the NHFOV group – 3.7% ( p = 0.001). In children a gestation period of 26–29 weeks, the opposite results were noted. Retinopathy of prematurity was detected in 80% (12) of children on NHFOV and 12.5% (2) who received NIPPV ( p = 0,001)). There were also statistically significant differences in the frequency of BPD formation – 9 cases in the first group, 13 cases in the second group ( p = 0.04). Conclusion . The use of NIPPV as a starting method of respiratory support is indicated to newborns with the gestation age of 26–29 weeks, and while in newborns with the gestation period of 30–32 weeks, the use of NHFOV is highly effective.

Comparison of three different noninvasive ventilation strategies as initial respiratory support in very low birth weight infants with respiratory distress syndrome: A retrospective study

BackgroundThere is inadequate evidence regarding which noninvasive ventilation (NIV) is superior for initial respiratory support of preterm infants with respiratory distress syndrome. ObjectivesTo compare the failure of noninvasive ventilation (NIV) and neonatal outcomes between nasal continuous positive airway pressure (NCPAP), bi-level positive airway pressure (BiPAP), and nasal intermittent positive pressure ventilation (NIPPV) as the initial respiratory support with less invasive surfactant administration (LISA) in very low birth weight (VLBW) infants. MethodsMedical records of 419 VLBW infants born at 26–30weeks’ gestation who did not require intubation in the delivery room and were initially supported with either NCPAP (n=221), BiPAP (n=101), or NIPPV (n=97) were retrospectively reviewed. The LISA approach was preferred in cases of surfactant requirement. The primary outcome was the failure of NIV within the first 72h of life. Failure of NIV was defined as the persistence or recurrence of one or more of the following: hypoxemia, respiratory acidosis, more than one episode of apnea requiring bag and mask ventilation or more than six episodes of apnea requiring stimulation over a 6-h period. Data were analyzed using univariate and multivariate logistic regression analysis. ResultsFailure of NIV within the first 72h of life was significantly higher in the NCPAP group (29.4%) compared with the BiPAP (12.9%) or NIPPV (12.4%) group (P<0.001). However, the BiPAP and NIPPV groups were not different in terms of NIV failure (P=0.91). Multivariable logistic regression analysis showed that antenatal steroid administration (OR: 0.49, 95% CI: 0.27–0.90; P=0.02) and gestational age˂28weeks (OR: 2.03, 95% CI: 1.18–3.49; P=0.01) were independent factors that influence failure of NIV within the first 72h of life. ConclusionCompared with NCPAP, the use of NIPPV/BiPAP strategies for initial respiratory support can reduce the need for invasive ventilation in infants born at 26–30weeks’ gestation.

Three non-invasive ventilation strategies for preterm infants with respiratory distress syndrome: a propensity score analysis.

IntroductionThe present study was designed and conducted to compare the efficacy between nasal continuous positive airway pressure (NCPAP), nasal intermittent positive-pressure ventilation (NIPPV), and noninvasive high-frequency oscillatory ventilation (NHFOV) as the primary noninvasive ventilation in preterm infants with respiratory distress syndrome (RDS).Material and methodsThis multicenter retrospective cohort study was performed using data from four tertiary neonatal intensive care units (NICUs) in China between 2016 and 2018. 512 preterm infants with RDS who received early non-invasive ventilation (NIV) were analyzed. Propensity score analysis with 1 : 1 matching was performed with the nearest neighbor matching method using calipers of width equal to 0.1 of the standard deviation of the logit of the propensity score. The primary outcome was the need for intubation and invasive mechanical ventilation (IMV) within the first 7 days after birth. Secondary outcomes were days of hospitalization, predischarge mortality, rate of retinopathy of prematurity (ROP) > stage II, rate of bronchopulmonary dysplasia (BPD) at 36 weeks post-menstrual age, rate of air leaks, rate of intraventricular hemorrhage (IVH) ≥ grade 3, and rate of necrotizing enterocolitis (NEC) ≥ stage II.ResultsPropensity score matching identified 126 infants in each cohort (NHFOV vs. NIPPV), 96 infants in each cohort (NHFOV vs. NCPAP), 134 infants in each cohort (NIPPV vs. NCPAP) respectively. The need for IMV was significantly lower in the NHFOV as compared with NCPAP and NIPPV groups respectively (13/126 vs. 27/126, p = 0.016; 9/96 vs. 20/96, p = 0.027), while no difference was observed between NIPPV and NCPAP groups (25/134 vs. 25/134, p = 0.805). However, the number of days of hospitalization in NIPPV was significantly lower than that of the NCPAP group (24.8 ±14.6 days vs. 33.2 ±20.2 days p = 0.002). In subgroup analyses, the need for IMV was significantly lower in the NHFOV group than in the NCPAP and NIPPV group (7 : 79 vs. 15 : 74; 95% CI: 1.00–6.836; p = 0.044 and 11 : 102 vs. 22 : 98; 95% CI: 1.092–5.251; p = 0.026), and there was no difference between NIPPV and NCPAP in the preterm infants at ≤ 32 weeks’ gestational age. There were no significant differences among three groups (p > 0.05 respectively) regarding secondary outcomes.ConclusionsIn this multicenter retrospective cohort study, NHFOV significantly reduced the need for IMV within the first 7 days as compared to NCPAP and NIPPV in the treatment of preterm infants with RDS without increasing the incidence of adverse events. However, NIPPV was not found to be superior to NCPAP for decreasing the need for IMV in the treatment of preterm infants with RDS.

Lung deposition of nebulized surfactant in newborn piglets: Nasal CPAP vs Nasal IPPV.

Nasal continuous positive airway pressure support (nCPAP) is the standard of care for prematurely born infants at risk of neonatal respiratory distress syndrome (nRDS). However, nasal intermittent positive pressure ventilation (NIPPV) may be an alternative to nCPAP in babies requiring surfactant, and in conjunction with surfactant nebulization, it could theoretically reduce the need for invasive mechanical ventilation. We compared lung deposition of nebulized poractant in newborn piglets supported by nCPAP or NIPPV. Twenty-five sedated newborn piglets (1.2-2.2 kg) received either nCPAP (3 cmH2 O, n = 12) or NIPPV (3 cmH2 O positive end expiratory pressure+3 cmH2 O inspiratory pressure, n = 13) via custom-made nasal prongs (FiO2 0.4, Servo-i ventilator). Piglets received 200 mg kg-1 of technetium-99m-surfactant mixture continuously nebulized with a customized eFlow-Neos investigational vibrating-membrane nebulizer system. Blood gases were taken immediately before, during, and after nebulization. The deposition was estimated by gamma scintigraphy. Mean surfactant deposition in the lungs was 15.9 ± 11.9% [8.3, 23.5] (mean ± SD [95% CI]) in the nCPAP group and 21.6 ± 10% [15.6, 27.6] in the NIPPV group (P = .20). Respiratory rates were similar in both groups. Minute volume was 489 ± 203 [360, 617] in the nCPAP group and 780 ± 239 [636, 924] mL kg-1 min-1 in the NIPPV group (P = .009). Blood gases were comparable in both groups. Irrespective of the noninvasive ventilatory support mode used, relatively high lung deposition rates of surfactant were achieved with nebulization. The amounts of deposited surfactant might suffice to elicit a pulmonary function improvement in the context of nRDS.

Comparing the Efficacy of NCPAP and NIPPV in Infants with RDS after Extubation; A Randomized Clinical Trial

Background: Respiratory distress syndrome (RDS) is the most common respiratory disorder of premature infants and leading cause of mortality. The main progress in RDS management is attributable to prescription of surfactant for fastening pulmonary maturation.Objectives: In this study we aimed to compare nasal continuous positive airway pressure (NCPAP) with nasal intermittent positive pressure ventilation (NIPPV) in infants with RDS lower than 1800 gr of birthweight.Methods: In this randomized clinical trial, infants with confirmed diagnosis of RDS who underwent treatment with surfactant and mechanical ventilation were randomly allocated to two NCPAP and NIPPV groups. Duration of hospitalization, oxygen therapy, respiratory protection, need for re-intubation and complications were recorded in a pre-designed checklist. Results: Eventually 60 (37 males and 23 females) infants with mean gestational ages of 31.73±1.72 weeks in NCPAP and 32.6±1.92 weeks in NIPPV group underwent analysis (p=0.096). Infants in NCPAP group underwent mechanical ventilation for a mean duration of 3.3±1.7 days; while it was 2.4±0.96 days for infants in NIPPV group (p=0.026). The mean received doses of surfactant was 2.36±0.66 in NCPAP and 1.9±0.25 in NIPPV group (p=0.005). After intervention, infants in NCPAP group had a mean arterial oxygen saturation of 91.36±3.03%; while it was 91.3±4.03% for those in NIPPV group (p=0.669). Mean arterial oxygen pressure was 67.6±6.91 mmHg in NCPAP group and 75.2±7.2 mmHg in NIPPV group after intervention (p=0.045).Conclusion: We found that NIPPV is more effective than NCPAP in decreasing need for reintubation and invasive mechanical ventilation in premature infants with respiratory distress syndrome and it also shortens the duration of hospitalization.

Comparing the Efficacy of Nasal Continuous Positive Airway Pressure and Nasal Intermittent Positive Pressure Ventilation in Early Management of Respiratory Distress Syndrome in Preterm Infants.

ObjectivesThere is a tendency to use noninvasive ventilation (NIV) as a substitute for mechanical ventilation in preterm infants who need respiratory support. Two important modes of NIV include nasal continuous positive airway pressure (NCPAP) and nasal intermittent positive pressure ventilation (NIPPV). We sought to compare the efficacy of NCPAP and NIPPV as early respiratory support in preterm infants with respiratory distress syndrome in reducing the need for intubation, surfactant administration, and mechanical ventilation.MethodsWe conducted a randomized clinical trial. Sixty-one preterm infants with a gestational age of 28–32 weeks and a birth weight < 1500 g were randomly allocated to early NCPAP (n = 31) or NIPPV (n = 30) groups. The primary outcome was the need for intubation and mechanical ventilation in first 72 hours of life and the secondary outcome was oxygen dependency beyond day 28 post-birth.ResultsSurfactant replacement therapy was done in 15 neonates (50.0%) in the NIPPV group and 19 neonates (61.3%) in the NCPAP group, odds ratio (OR) = 1.58 (95% confidence interval (CI): 0.57–4.37; p = 0.370). Intubation and mechanical ventilation in the first 72 hours of life were needed in five cases (16.7%) in the NIPPV group and two cases (6.5%) in the NCPAP group, OR = 2.90 (95% CI: 0.51–16.27; p = 0.250). The mean duration of hospitalization was 26.2±17.4 days in the NIPPV group and 38.4±19.2 days in the NCPAP group, p = 0.009. Bronchopulmonary dysplasia (BPD) occurred in two (6.7%) neonates in the NIPPV group and eight (25.8%) neonates in the NCPAP group, p = 0.080.ConclusionsNIPPV and NCPAP are similarly effective as initial respiratory support in preterm infants in reducing the need for mechanical ventilation and occurrence of BPD. The duration of hospitalization was significantly reduced using NIPPV in our study.KeywordsNasal Continuous Positive Airway Pressure; Preterm Infants; Mechanical Ventilation; Bronchopulmonary Dysplasia; Respiratory Distress Syndrome, Newborn.

A Comparative Study of Treatment Response of Respiratory Distress Syndrome in Preterm Infants: Early Nasal Intermittent Positive Pressure Ventilation versus Early Nasal Continuous Positive Airway Pressure

Background Infant respiratory distress syndrome (IRDS) is one of the main causes of serious complications and death in preterm infants. Both Nasal Continuous Positive Airway Pressure (NCPAP) and Nasal Intermittent Positive Pressure Ventilation (NIPPV) are known as the most common treatment strategies for IRDS. The present study intended to compare NCPAP and NIPPV in the treatment of preterm infants with respiratory distress syndrome. Materials and Methods To this double blind clinical trial study during a one-year period (2016 to 2017) in Fatemieh Hospital in Hamadan city (Iran), about 60 preterm RDS infants were randomly assigned into two treatment groups; the NIPPV group received the PIP (14–20 cmH2O), RR: 30-50/min, PEEP (5–6 cmH2O), FiO2 up to 60%. The NCPAP group received PEEP (5-6 cmH2o), Flow: 6-7 L/min, and FiO2 up to 60% Results There was not any significant difference in the mean values of gestational age (30.07±1.50 vs. 30.07±2.05; P>0.05), birth weight (1259±263 vs. 1235±285; P>0.05), and 1-minute Apgar score (5.53±1.13 vs. 5.33±1.34; P>0.05) between NIPPV and NCPAP treatment groups. Besides, the rate of recovery, mortality and disease complications was not significantly different between both groups. However, the duration of respiratory support was less in NIPPV than NCPAP (34.9±33.8 vs. 68.4±32 h; P=0.001). Conclusion According to the results, there was not significant advantage between the NIPPV vs. NCPAP methods in the treatment of RDS in preterm infants with very low birth weight.

Surfactant replacement therapy in combination with different non-invasive ventilation techniques in spontaneously-breathing, surfactant-depleted adult rabbits.

Nasal intermittent positive pressure ventilation (NIPPV) holds great potential as a primary ventilation support method for Respiratory Distress Syndrome (RDS). The use of NIPPV may also be of great value combined with minimally invasive surfactant delivery. Our aim was to implement an in vivo model of RDS, which can be managed with different non-invasive ventilation (NIV) strategies, including non-synchronized NIPPV, synchronized NIPPV (SNIPPV), and nasal continuous positive airway pressure (NCPAP). Forty-two surfactant-depleted adult rabbits were allocated in six different groups: three groups of animals were treated with only NIV for three hours (NIPPV, SNIPPV, and NCPAP groups), while three other groups were treated with surfactant (SF) followed by NIV (NIPPV+SF, SNIPPV+SF, and NCPAP+SF groups). Arterial gas exchange, ventilation indices, and dynamic compliance were assessed. Post-mortem the lungs were sampled for histological evaluation. Surfactant depletion was successfully achieved by repeated broncho-alveolar lavages (BALs). After BALs, all animals developed a moderate respiratory distress, which could not be reverted by merely applying NIV. Conversely, surfactant administration followed by NIV induced a rapid improvement of arterial oxygenation in all surfactant-treated groups. Breath synchronization was associated with a significantly better response in terms of gas exchange and dynamic compliance compared to non-synchronized NIPPV, showing also the lowest injury scores after histological assessment. The proposed in vivo model of surfactant deficiency was successfully managed with NCPAP, NIPPV, or SNIPPV; this model resembles a moderate respiratory distress and it is suitable for the preclinical testing of less invasive surfactant administration techniques.

Decrease in delivery room intubation rates after use of nasal intermittent positive pressure ventilation in the delivery room for resuscitation of very low birth weight infants

BackgroundThe literature supports minimizing duration of invasive ventilation to decrease lung injury in premature infants. Neonatal Resuscitation Program recommended use of non-invasive ventilation (NIV) in delivery room for infants requiring prolonged respiratory support. ObjectiveTo evaluate the impact of implementation of non-invasive ventilation (NIV) using nasal intermittent positive pressure ventilation (NIPPV) for resuscitation in very low birth infants. Study designRetrospective study was performed after NIPPV was introduced in the delivery room and compared with infants receiving face mask to provide positive pressure ventilation for resuscitation of very low birth weight infants prior to its use. Data collected from 119 infants resuscitated using NIPPV and 102 infants resuscitated with a face mask in a single institution. The primary outcome was the need for endotracheal intubation in the delivery room. Data was analyzed using IBM SPSS Statistics software version 24. ResultsA total of 31% of infants were intubated in the delivery room in the NIPPV group compared to 85% in the Face mask group (p=<0.001). Chest compression rates were 11% in the NIPPV group and 31% in the Face mask group (p<0.001). Epinephrine administration was also lower in NIPPV group (2% vs. 8%; P=0.03). Only 38% infants remained intubated at 24hours of age in the NIPPV group compared to 66% in the Face mask group (p<0.001). Median duration of invasive ventilation in the NIPPV group was shorter (2days) compared to the Face mask group (11days) (p=0.01). The incidence of air-leaks was not significant between the two groups. ConclusionNIPPV was safely and effectively used in the delivery room settings to provide respiratory support for VLBW infants with less need for intubation, chest compressions, epinephrine administration and subsequent invasive ventilation.

Study on the prognosis of premature infants with recurrent apnea treated with nasal intermittent positive pressure ventilation

Objective To investigate the effect of nasal intermittent positive pressure ventilation(NIPPV) on the prognosis of infants with recurrent apenea of premature(AOP) for 12 months of correcting gestational age, thus to provide reference for the treatment of AOP. Methods The premature infants with recurrent AOP of the neonatal intensive care unit were divided into observation group and control group according to the random number table method.The observation group was treated with NIPPV, the control group was treated with nasal continuous positive airway pressure(NCPAP). All living premature infants were followed up for early intervention, hearing, visual acuity, physical and mental development after hospital discharge.Neonatal behavioral neurological assessment(NBNA) was given to the premature infants at the corrected gestational age of 40 weeks and 42 weeks, CDCC was used to test of the corrected gestational age of 1 year old, and the mental retardation, cerebral palsy, hearing impairment, severe deafness, blindness were assessed and compared. Results 123 cases were selected, including 2 cases were abandoned in the treatment, 7 cases died(4 cases died during hospitalization, 3 cases died after hospital discharge), 5 cases were lost following up after hospital discharge, 12 cases were treated with poor compliance, the actual research subjects were 97 cases, 51 cases in NIPPV group, 46 cases in NCPAP group.In NIPPV group, the NBNA score more than 35 points of 40 weeks and 42 weeks were in 38 cases(74.5%), 47 cases(92.2%) respectively, which in NCPAP group were respectively in 28 cases(60.9%), 37 cases(80.4%). There were statistically significant differences between the two groups(t=14.786, 4.149, all P<0.05). In NIPPV group, MDI score<80 points, PDI score<80 points, mental retardation, cerebral palsy were respectively in 7 cases(13.7%), 6 cases(11.8%), 3 cases(5.9%), 1 case(2.0%), which in NCPAP group were respectively in 15 cases(32.6%), 14 cases(30.4%), 8 cases(17.4%), 5 cases(10.9%), there were statistically significant differences between the two groups(χ2=10.040, 9.765, 5.944, 6.663, all P<0.05). In NIPPV group, the hearing impairment, very severe deafness, blindness were respectively in 2 cases(3.9%), 0 cases(0.0%), 0 cases(0.0%), which in NCPAP group were respectively in 7 cases(15.2%), 2 cases(4.3%), 2 cases(4.3%), there were statistically significant differences between the two groups(χ2=7.037, 4.082, 4.082, all P<0.05). Conclusion NIPPV in the treatment of premature infants with recurrent AOP has a certain improvement in prognosis. Key words: Intermittent positive-pressure ventilationt; Infant, premature; Apnea; Prognosis

Prospective economic evaluation alongside the non-invasive ventilation trial.

To determine the cost-effectiveness of nasal continuous positive pressure (nCPAP) compared with nasal intermittent positive pressure ventilation (NIPPV) in the context of the reported randomized clinical trial. Using patient-level data from the clinical trial, we undertook a prospectively planned economic evaluation. We measured costs, from a third-party payer perspective in all patients, and from a societal perspective in a subgroup with a time horizon through the earlier of discharge, death or 44 weeks post-menstrual age. From the third-party payer perspective, the mean cost of hospitalization per infant was statistically similar, $143 745 in the NIPPV group compared to $140 403 in the nCPAP group. Cost-effectiveness evaluation revealed a 61% probability that NIPPV is more expensive and less effective than nCPAP. Similar results were found in subgroup analysis from a societal perspective. In addition to being clinically equivalent, economic evaluation confirms that NIPPV, as employed in this trial, is also not economically favorable.